On Friday, the Trump administration rejected a Biden plan that would require Medicare and Medicaid to cover obesity drugs and expand access to millions of people.
In accordance with the law that determines the drug benefits of Medicare’s section D, the program of the program is prohibited for “weight loss”. However, the Biden administration’s proposal last November tried to prohibit this, arguing that drugs would be allowed to treat obesity and related conditions.
The expansion of drugs would cost the federal government for billions of dollars. Congress Budget Office estimated The federal expense will be about 35 billion dollars for 10 years.
The decision announced on Friday, 438 pages larger arrangement Private Insurance, which updates Medicare’s section D drug benefits and medicare advantage, plans that about half of the medicare beneficiaries are currently using it.
Medicare and Medicaid Service Centers Spokesman Catherine Howden said that an E -Postada agency believes that the expansion of the scope is not “right now”. However, he said that the agency did not exclude the scope and that he could “take into account future policy options” for drugs.
Medicare, a government insurance program for Americans and disabled people over the age of 65, covers weight loss medications for patients with diabetes, and a much smaller subset of obese and at the same time heart problems or sleep apnea.
The Biden plan would expand patients who were obese but did not have these diseases. Medicare officials predicted that about 3.4 million more people would choose to take drugs within the scope of policy.
The most popular weight loss drugs are made by Novo Nordisk, which sells the drug for obesity and wegovy for obesity and for diabetes for diabetes, and by hand Lilly, who sells its product as Mounjaro for zepbound for obesity and diabetes.
Eli Lilly and Novo Nordisk now offer their products $ 350 with $ 500 One month for patients who pay with their own money instead of insurance. However, until recently, patients sometimes paid more than $ 1,300 per month.
Health Secretary Robert F. Kennedy Jr., criticism of weight loss drugs was vocal and said they were lower than consuming healthy food, he said.
Drugs have shown that clinical studies have benefits beyond weight loss such as heart attacks and prevention of paralysis.
Expanded scope defenders argued that the government’s expenditures on drugs would at least pay for themselves in partially in the long run. They say that patients will become healthier, which will prevent expensive medical bills. It is not yet clear whether such savings will happen.
The state medicaid programs that provide health services to the poor can now cover the drugs and select the scope. Some. If a wider policy was concluded, the scope would be necessary in every state.
Obesity drugs cost Medicare and Medicaid to hundreds of dollars per month every month, but the exact prices are hidden.
Many employers and private health insurance plans do not cover drugs. Some have reduced the scope of drugs by referring to high costs after their popularity increased, including the benefits of government employees in North Carolina and Western Virginia.
Without the scope of insurance, many patients in Medicare and Medicaid rely on cheap imitating versions of drugs produced through a drug mixing process, known as a compound. These versions, which are allowed because brand names are insufficient, can cost less than 200 dollars per month. However, the regulators ordered such sales It ends soon Because the supply of brand products improved.
The Republicans in the Congress stated that they were interested in asking Medicare to include drugs. Earlier this year, the idea was included in the list of policy options produced by the Assembly Budget Committee. However, it does not seem to be an important priority at the moment.
To reduce costs, Medicare chose Novo Nordisk’s Wegovy for negotiations to reduce prices under a law spent by a democratic controlled congress in 2022. These low prices would be a change in 2027 with the potential to limit long -term scope costs for appropriate people.
